Prevalence Of Extraintestinal Manifestations Research Articles

Prevalence of Classical Extraintestinal Manifestations among Inflammatory Bowel Disease Patients in Saudi Arabia: A Single Tertiary Center Experience.

Patients with inflammatory bowel disease (IBD) may also experience extraintestinal manifestations (EIMs), which can affect various organ systems, and their occurrence is based on disease activity. To determine the prevalence of EIMs and their most common types among IBD patients from Saudi Arabia. This retrospective study included all IBD patients aged 14-80 years who visited the Gastroenterology and Hepatology clinics at King Fahad Medical City, Riyadh, between February 2017 and December 2022. The collected data included demographic characteristics, disease characteristics, EIMs, and treatment. The study included 578 IBD patients, of which 65 (11.2%) had at least one EIM, with primary sclerosing cholangitis (46.2%) and sacroiliitis (16.9%) being the most common. Patients with ulcerative colitis were more likely to have EIMs than those with Crohn's disease (15.1% vs. 9%; P = 0.026). Patients with ileocolonic (L3) Crohn's disease reported a higher prevalence of EIMs (7.5%) than those with other disease locations (P = 0.012), while in patients with ulcerative colitis, those with extensive colitis (E3) reported higher prevalence of EIMs (19.2%) (P = 0.001). Patients receiving 6 MP had a significantly high prevalence of EIMs (P = 0.014). The prevalence of extraintestinal manifestations among IBD patients in Saudi Arabia is 11.2%. These findings suggest the need for clinicians to screen for EIMs and manage them early. Further research is needed to understand the mechanisms underlying EIMs for the development of more effective treatments.

Clinical Phenotype and Disease Course of Inflammatory Bowel Disease in Iran: Results of the Iranian Registry of Crohn's and Colitis (IRCC).

Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East. We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries. In total, 9746 patients with ulcerative colitis (UC) (n=7793), and Crohn's disease (CD) (n=1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of stricturing behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF). In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations.

The Prevalence of extraintestinal manifestations in Inflammatory Bowel Disease

INTRODUCTION: The term inflammatory bowel disease (IBD) refers to a chronic inflammatory disease of the gastrointestinal tract of unclear pathogenesis. IBD consists of ulcerative colitis (UC) and Crohn's disease (CD). The two most common manifestations of the disorder, both have a chronic course with episodes of acute activity. Their underlying pathogenesis and symptoms, however, are quite distinct. IBD has a multiple factor etiology involving genetics, immunological dysregulation and dysbiosis of the intestinal microbiome. The resulting chronic inflammation of the entire body is the cause of the symptoms and signs of the condition. Extraintestinal manifestations (EIM) occur in 5% to 50% of IBD patients over the course of their lifetime.
 PURPOSE: The aim of the study is to present the current state of knowledge about the prevalence of extraintestinal manifestations in Inflammatory Bowel Disease.
 MATERIALS AND METHOD: The available literature in PubMed was reviewed to write the article, using the keywords ,,inflammatory bowel disease”, ,,Crohn’s disease”, ,, ulcerative colitis”, ,,extraintestinal manifestations IBD”. 
 CONCLUSION: Extraintestinal manifestations are evidence that IBD is not only confined to the intestine, these may involve many different organs other than the gut and may be more devastating than the IBD. Screening for EIM in these patients and prompt adequate treatment are essential. To adequately manage EIM and improve the quality of life of our patients, appropriate treatment regimens and therapies are required in a multidisciplinary team approach. Due to the lack of available dedicated diagnostic biomarkers for EIM, consideration of concomitant extraintestinal conditions in patients with inflammatory bowel disease might help in the selection and management of them. Clinicians caring for patients with IBD must be aware of these various systemic manifestations, as failure to diagnose and treat them early can result in significant morbidity.

Prevalence of Extraintestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Inflammatory bowel disease (IBD) is a multisystem disease impacting various body systems including musculoskeletal, ocular, skin, hepatobiliary, pulmonary, cardiac, and haematological systems. The extraintestinal manifestations of IBD are frequent, common in both ulcerative colitis (UC) and Crohn's disease (CD), and impact the morbidity and mortality of patients. The Embase, Embase classic, and PubMed databases were searched between January 1979 and December 2021. A random effects model was performed to find the pooled prevalence of joint, ocular, and skin extraintestinal manifestations of UC and CD. Fifty-two studies were included that reported on 352 454 patients. The prevalence of at least 1 joint, ocular, or skin extraintestinal manifestation in all IBD, UC, and CD was 24%, 27%, and 35% respectively. The prevalence between UC and CD were similar for pyoderma gangrenosum and axial joint manifestations. Ocular manifestations were found to be more common in CD than in UC. Peripheral joint manifestations and erythema nodosum were found to be more common in CD than UC. To our knowledge, this is the first meta-analysis that reports on the prevalence of at least 1 joint, ocular, or skin extraintestinal manifestation in IBD. Our results are largely consistent with figures and statements quoted in the literature. However, our findings are based on significantly larger cohort sizes. Thus, our results have the potential to better power studies and more accurately counsel patients.

What are the risk factors for extraintestinal manifestations in inflammatory bowel diseases?

Extraintestinal manifestations (EIMs) are common in patients with inflammatory bowel disease (IBD); however, studies surrounding EIMs are lacking, particularly in Asia. This study aimed to identify risk factors by analyzing the characteristics of patients with EIMs. From January 2010 to December 2020, the medical records of 531 patients diagnosed with IBD (133 with Crohn disease [CD] and 398 with ulcerative colitis [UC]) were reviewed. The patients' baseline characteristics and risk factors were analyzed by dividing them into 2 groups according to EIMs presence. The prevalence of EIMs in all patients with IBD was 12.4% (n = 66), of which CD and UC prevalences were 19.5% (n = 26) and 10.1% (n = 40), respectively. The articular (7.9%, n = 42), cutaneous (3.6%, n = 19), ocular (1.5%, n = 8), and hepatobiliary types (0.8%, n = 4) of EIMs were observed. Two or more EIMs occurred in only 1.2% of all IBD patients (n = 6). Multivariate analysis revealed that the risk factors for the occurrence of EIMs were a follow-up period ≥ 10 years (odds ratio, 2.106; 95% confidence interval, 1.187-3.973; P = .021) and treatment with biologics (odds ratio, 1.963; 95% confidence interval, 1.070-3.272; P = .037). The EIMs prevalence in patients with IBD was 12.4%, and the particular type was the most common, with EIMs occurring more frequently in patients with CD than in those with UC. Patients who have been treated for IBD for more than 10 years or who are using biologics should be carefully monitored as they are at high risk for EIMs.

P207 Colonic location at diagnosis of pediatric-onset Crohn’s disease is associated with a pejorative disease course: a two decades population-based study

Abstract Background Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease. Methods All children (< 17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were followed retrospectively until 2013. Presentation at diagnosis, risks of complicated disease, surgery, hospitalization and exposure to treatments in ileal CD (L1), colonic CD (L2) and UC were compared. Disease location was defined at diagnosis. In case of extension of the disease (L1 or L2 to L3), follow-up was censored. Results A total of 215 L1 patients, 234 L2 patients and 337 UC patients were included. At diagnosis, the proportion of males (L1 53.5%; L2 53.4%; UC 42.7%; p=0.012), age at diagnosis (15.0; 13.7; 14.0 years; p=0.003), family history of IBD (12.6%; 12.7%; 5.0%; p=0.005), diagnostic delay (3.0; 3.0; 2.0 months; p=0.001) and smoking prevalence (11.6%; 8.1%; 5.6%; p=0.041) were different between the three groups. Bloody stool and diarrhea at diagnosis was observed in respectively 14.9%, 44.4%, and 91.1% (p < 0.001) and 47.0%, 71.8%, and 65.0% (p < 0.001) of L1, L2 and UC. At diagnosis, granuloma was identified in 12.6% of L1 patients and 31.2% of L2 patients (p<0.001). The risk of extension to L3 was significantly higher in the L2 group than in the L1 group (at 5 years - 37% vs. 14%, p<0.001). Compared to L1 location, L2 was associated with a lower risk of luminal fistula (HR 0.41 [0.21-0.79], p=0.008) but a higher risk of anoperineal lesion (HR 2.11 [1.29-3.45], p=0.003). The prevalence of extra-intestinal manifestations, articular (p<0.001) and cutaneous (p<0.001) was higher in L2. While the risk of surgery was significantly higher in case of L1 (at 5 years – L1 37%, L2 13% and UC 13%; p<0.001), the risk of hospitalization (at 5 years - 22%, 39% and 33%; p=0.01), exposure to corticosteroids (at 5 years - 55%, 69% and 67%; p<0.001), immunosuppressants (at 5 years - 47%, 61% and 42% - p<0.001) and anti-TNF (at 5 years - 16%, 35% and 22%; p<0.001) were higher in case of L2. Conclusion The clinical presentation at diagnosis and natural history of ileal and colonic CD differ significantly. Colonic location is associated with a high risk of perianal CD, extra-intestinal manifestations, hospitalization as well as exposure to steroids, immunosuppressants and anti-TNF. These differences may justify different therapeutic strategies in the future.

S1024 Dermatologic Manifestations in Patients With Inflammatory Bowel Disease

Introduction: There are several extraintestinal manifestations of inflammatory bowel disease (IBD) including cutaneous. Furthermore, new biologics have been also associated with cutaneous side effects. However, the prevalence of extraintestinal manifestations in patients with IBD and those who receive anti-tumor necrosis factors (anti-TNFs) have not been extensively studied. Using a large database, we sought to describe the rates of selected cutaneous manifestations of IBD as long as adverse effects of anti-TNFs. Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of inflammatory bowel disease between 2017-2021 was identified. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. Results: Of the 34,277,840 individuals in the database, 142,890 (0.42%) and 165,960 (0.48%) had a diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD) respectively. Baseline characteristics of patients with IBD and control group are shown in Table 1. Compared to the non-IBD group, patients with a history of IBD had a higher rates of multiple skin conditions including erythema nodosum, pyoderma gangrenosum, sweet syndrome, psoriasis, lichen planus, alopecia, eczema, vitiligo, bullous disease, and skin cancers. Among IBD patients, those who are on anti-TNFs and immunomodulator (IM) had higher rates of herpes/zoster and candida infections, lichen planus, alopecia, eczema and melanoma and non-melanoma skin cancers compared to anti-TNFs alone (Table 3). Conclusion: In this large database, we found a higher risk association between IBD and multiple skin conditions including skin cancers. Interesting, IBD patients treated with anti-TNFs had double rates of melanoma and non-melanoma skin cancers. Further epidemiological studies are required to validate these findings and increase attention to adequately screening for skin cancers and dermatology referral while taking care of IBD.Figure 1

S892 Impact of Concomitant Hypothyroid Disease and Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD), comprised of Ulcerative Colitis (UC) and Crohn’s Disease (CD), is caused by a combination of environmental factors, immune dysregulation, and genetic susceptibility. Other immune-mediated phenomena, like hypothyroidism, have also been observed in this population. Thus, we sought to explore clinical characteristics and outcomes among IBD patients with hypothyroidism compared to IBD patients without hypothyroidism. Methods: In a retrospective chart review from a large, tertiary, academic medical center, baseline demographics and clinical data were extracted for patients diagnosed with either UC or CD and having at least one thyroid stimulating hormone (TSH) measurement from prior to 2016. Based on the presence of a documented hypothyroidism ICD-10 code, patients were then divided into two groups, those with IBD alone and those with both IBD and hypothyroidism, as described in Figure. Individual charts were then further examined for disease characteristics, biomarkers, healthcare utilization, medication use, and other comorbidities from 2016 to 2022. Demographic and clinical variables were then compared between the two groups, as seen in Table. Results: We identified 166 adult IBD patients (CD 53%, UC 47%). The mean age was 62.9 years. Among these patients, 116 patients (69.9%) had IBD and hypothyroidism. The most common causes of hypothyroidism were Hashimoto, subclinical, and acquired hypothyroidism. No differences were noted in race, smoking status, or BMI. IBD disease location, behavior, and prevalence of extra-intestinal manifestations did not significantly differ between the two study groups. Both groups had similar number of colonoscopies, hospitalizations, as well as comparable medication use (SSRI/SNRI, steroids, 5-ASA, immunomodulators, biologics). However, patients with IBD and hypothyroidism had higher rates of anemia (p=0.03), hypoalbuminemia (p=0.007), and CRP elevations (p=0.002). Furthermore, patients with both IBD and hypothyroidism had a greater median number of emergency department visits (p=0.039) and axial radiography (p=0.002). Conclusion: IBD patients with hypothyroidism experience a more severe disease course with higher biomarkers of inflammation and healthcare utilization than those without hypothyroidism despite similar IBD phenotype and therapy exposures. This highlights a potential subgroup of IBD patients who may be at risk for increased disease severity and associated poor outcomes.Figure 1.: Flow diagram of retrospective cohort study comparing clinical characteristics and outcomes among IBD patients with hypothyroidism compared to IBD patients without hypothyroidism Table 1. - Baseline characteristics, univariate analysis and multivariate analysis of biomarkers, lab abnormalities, and healthcare utilization Baseline Characteristics at enrollment (Collected prior to 2016) Total Sample IBD only IBD + Thyroid disease P value n 166 50 116 Age, Mean (SD) 62.9 (18.3) 57.8 (19.9) 63.6 (17.3) 0.062 Female (n, %) 118 (71.1%) 30 (60%) 88 (75.9%) 0.039 White 138 41 (82%) 97 (83.6%) 0.798 Never Smoker 95 31 (62%) 64 (55.2%) 0.415 BMI (median, IQR) 25.3 (6.4) 26.0 (8.07) IBD subtype 0.116 CD 87 (52.7%) 31 (62%) 56 (48.7) UC 78 (47.3%) 19 (38%) 59 (51.3%) Disease duration (Years, median, IQR) 7.44 (3.8) 7.68 (4.1) 7.26 (3.6) 0.257 Hypothyroid Disease duration (Years, median, IQR) 7.74 (3.5) Elevated TSH ( >5) ever 55 (33.1%) 5 (10%) 50 (43.1%) < 0.001 Levothyroxine Rx ever 89 (53.9%) 1 (2%) 88 (76.5%) < 0.001 PTU or Methimazole Rx ever 3 (1.8%) 1 (2%) 2 (1.8%) 0.914 Intestinal Surgery ever 61 16 (32%) 45 (39.1%) 0.383 Extra-intestinal disease 19 (11.4%) 3 (6%) 16 (13.8%) 0.148 Univariate Analysis of Biomarkers, lab abnormalities, and Healthcare Utilization during study period (2016-22) Anemia ever 92 (55.8%) 21 (42.9%) 71 (61.2%) 0.03 Hypoalbuminemia ever 39 (23.5%) 5 (10%) 34 (29.3%) 0.007 CRP elevation ever 73 (51%) 12 (30%) 61 (59.2%) 0.002 ESR elevation ever 58 (43.6%) 10 (29.4) 48 (48.5) 0.053 Median # of Colonoscopy 1 (2) 0.5 (2) 1 (3) 0.326 Median # of ED visits 0 (2) 0 (1) 1 (2) 0.039 Median # of Hospitalizations 0 (2) 0 (1) 0.5 (3) 0.101 Median # of Xrays and CT scans 3 (8) 1 (4) 4 (8) 0.002 Multivariate Model of Biomarkers, lab abnormalities, and Healthcare Utilization during study period (2016-22) Adjusted Odds Ratio (95% CI) P-value Anemia ever 2.34 (1.16-4.71) 0.018 Hypoalbuminemia ever 3.82 (1.38-10.56) 0.010 CRP elevation ever 3.19 (1.45-7.03) 0.004 ESR elevation ever 2.21 (0.94-5.15) 0.068 >1 Colonoscopy 1.24 (0.62-2.46) 0.538 >1 ED visit 2.38 (1.17-4.84) 0.016 >1 Hospitalizations 1.59 (0.80-3.18) 0.188 >1 X-rays and CT scans 2.96 (1.43-6.14) 0.003

S2787 A Classic Cutaneous Manifestation of Newly Diagnosed Ulcerative Colitis

Introduction: Pyoderma gangrenosum (PG) is a rare dermatologic manifestation with an incidence of only 3 to 10 cases per million people per year. Though rare, PG and its association with systemic inflammatory disease is well described. This ulcerative, non-infectious neutrophilic dermatosis is most associated with inflammatory bowel disease (IBD) and is specifically associated with ulcerative colitis (UC) in 5 to 12% of cases, although fewer than 3% of patients with UC develop PG. Here we describe a case of a 36-year-old male who presented with progressively worsening bloody diarrhea associated with an exquisitely painful, ulcerative right shoulder lesion that was treatment-refractory to multiple courses of antibiotics. Case Description/Methods: A 36-year-old man with no significant past medical history presented with three weeks of watery diarrhea often mixed with blood and associated with generalized abdominal pain, weight loss, and malaise. He also reported a worsening right anterior shoulder lesion that he noticed prior to the onset of his gastrointestinal complaints and was refractory to treatment with courses of both TMP-SMX and minocycline. Initial CT imaging revealed pancolitis with perirectal and right lower quadrant reactive lymphadenopathy. Dermatopathology of the lesions obtained during admission revealed diffuse dermal neutrophilic infiltrates consistent with PG. He underwent colonoscopy which revealed inflammation in a continuous and circumferential pattern from rectum to cecum with no colonic sites spared. Tissue samples obtained during colonoscopy returned consistent with ulcerative pancolitis. He was started on intravenous steroids for three days followed by a switch to oral steroids with a marked improvement in abdominal pain, diarrhea, and appearance of the skin lesion. He was discharged with outpatient Gastroenterology follow up where he was initiated on biological therapy with continued improvement in symptomatology. (Figure) Discussion: The prevalence of extraintestinal manifestations (EIM) in patients with IBD range from 6 to 47%. This case exhibits how EIMs can be commonly misdiagnosed and subsequently mistreated, especially if dermatologic disease precedes the onset of gastrointestinal complaints. This case reinforces the importance of a detailed history and physical exam while ensuring documentation of an accurate timeline of symptom onset. This case also displays the importance of proper review of symptoms and further workup of dermatological lesions prior to assuming infectious etiology.Figure 1.: Right shoulder lesion on admission.

The relationship between inflammatory bowel diseases and kidney diseases

Inflammatory bowel diseases occupy a significant place among all diseases of the gastrointestinal tract. According to D. Corica, the prevalence of extra-intestinal manifestations in inflammatory bowel diseases ranges from 6 % to 46 %. Gastroenterologists are well aware of local intestinal manifestations of these diseases. The etiology of extra-intestinal manifestations is still unclear. However, it is well known that these injuries are not limited to the intestines and one of the target organs is the kidneys. The following review presents the analysis of possible pathogenetic mechanisms of intestinal and kidney lesions, such as Crohns disease, ulcerative colitis and urolithiasis, tubulointerstitial nephritis, glomerulonephritis and amyloidosis of the kidneys.

COMPARISON OF THE INFLAMMATORY BOWEL DISEASES PHENOTYPE AND COURSE IN THE ELDERLY- AND EARLY-ONSET PATIENTS

Abstract BACKGROUND AND AIMS It is unknown if clinical phenotype and course of the disease are comparable between early- and elderly-onset inflammatory bowel diseases (IBD). There is also an ongoing dispute on whether elderly-onset IBD is a separate entity. We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. METHODS This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) compared demographics, extent of ulcerative colitis (UC), Crohn’s disease (CD) location and behavior, extraintestinal manifestations, disease activity during the previous six months, and two weeks, IBD-related surgery and medications between early- and elderly-onset IBD. We defined early-onset and elderly-onset IBD as 30 years or less and 60 years and above, respectively. We used univariable analysis to investigate the association between age of diagnosis and outcomes. Variables with P-value &amp;lt;0.1 were entered into the generalized linear model to study the relative risk of age of diagnosis adjusted for gender and disease duration for the outcomes. RESULTS From 8911 IBD patients that were recruited in the IRCC from December 2017 till June 2021, 4503 were enrolled, including 4134 (46.4%) early-onset and 369 (4.1%) elderly-onset cases. Among them, 3596 (79.8%) had UC, and 907 (20.2%) had CD. Figure 1 shows relative risk of outcomes in patients with UC based on patients’ age of diagnosis adjusted for disease duration and gender. The risk of left colitis was 1.7 times higher among elderly-onset UC patients (95%CI:1.4-2.1, P&amp;lt;0.001). Early-onset IBD cases had a higher prevalence of extraintestinal manifestations (p&amp;lt;0.001). Early-onset UC cases more often used prednisolone (p=0.031), immunomodulators (p&amp;lt;0.001) and anti-tumor necrosis factors (TNF) (p=0.002). Elderly-onset UC patients had 0.7 times lower risk of active disease in the past six months in comparison with elderly-onset cases (95%CI:0.5-0.9, p=0.003). Elderly-onset CD patients had 1.7 times the risk of ilium involvement (95%CI: 1.1-2.5, p=0.010), and elderly-onset CD cases had 0.2 times the risk of stricture formation compared to early cases (95%CI:0.1-0.8, p=0.028). Early-onset CD was associated with higher use of prednisolone (p=0.024), immunomodulators (p&amp;lt;0.001) and anti-TNF (p=0.024). Disease activity during the previous six months , two weeks and IBD-related surgery were similar between the two groups. Figure 2 demonstrates relative risk of outcomes in patients with CD based on patients’ age of diagnosis adjusted for disease duration and gender. CONCLUSION Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use. There is a need for a more detailed investigation of treatment complications and surgery types in future studies.

Prevalence of Extra Intestinal Manifestations in Inflammatory Bowel Disease and Associated Risk Factors

Background and Aim: Ulcerative colitis (UC) is a subtype of inflammatory bowel disease that can develop extra-intestinal manifestations (EIMs) in a subgroup of patients. There is a scarcity of data on the prevalence of extra-intestinal manifestations (EIMs) in inflammatory bowel disease and their risk factors analyses. The present study aimed to evaluate the prevalence of extra-intestinal manifestations in ulcer colitis and its associated risk factors. Methodology: This prospective study was conducted on 334 inflammatory bowel disease patients who were followed for identification of EIMs associated risk factors in the Department of Medicine and Pulmonology, Ghulam Muhammad Medical College and Hospital (GMMCH)/ Civil Hospital, Sukkur for the duration of six months; from April 2021to September 2021. All the patients above 16 years and who had ulcerative colitis and Crohn’s disease (CD) were enrolled. Patient’s demographic and clinical details such as gender, education, age, smoking history, diagnosis of EMIs, age at IBD, different IBDs, surgical, and treatment details were recorded. Results: Out of 334 IBD patients, the prevalence of ulcerative colitis (UC) and Crohn’s disease (CD) was 38.9% (n=130) and 61.1% (n=204) respectively. The overall mean age of UC and CD patients was 38.6±6.8 and 42.7±8.5 years respectively. Of the total 130 CD patients, the prevalence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis and psoriasis was 20.8% (n=27), 3.8% (n=5) 4.6% (n= 6), 3.1% (n=4) , 2.3% (n=3), 3.8% (n=5), and 1.5% (n=2) respectively. Out of 204 CD patients, the incidence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis, and psoriasis was 32.8% (n=67), , 9.8% (n=20) , 5.9% (n=12) , , 6.4% (n=13) , 2% (n=4) , 1% (n=2) and 2% (n=4) respectively. Risk factors for EMIs were identified using multiple logistic regression. In ulcerative colitis patients, no risk factors were identified. Conclusion: Our study concluded that extra-intestinal manifestations are a major issue in ulcerative colitis and Crohn’s disease patients. Moreover, the ongoing EIMs in Crohn’s disease patients are significantly associated with inflammatory bowel disease positive family history, and active disease. Therapeutic management and diagnostic facilities can be improved with the determination of extra-intestinal manifestation prevalence and related risk factors. Keywords: Crohn’s Disease, Extra-intestinal Manifestation, Inflammatory Bowel Disease

Real world practice of medical treatment for moderate and severe inflammatory bowel diseases in Russian Federation, Republic of Belarus and Republic of Kazakhstan: intermediate results of the INTENT study

Real world practice of medical treatment for moderate and severe inflammatory bowel diseases in Russian Federation, Republic of Belarus and Republic of Kazakhstan: intermediate results of the INTENT study

Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors.

The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are scanty and highly variable. Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtainedand physicalexamination wasdone. Presence of EIM was confirmed bya consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with EIM. The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.

Characterization and prevalence of extraintestinal manifestations in a cohort of patients with inflammatory intestinal disease in Medellin, Colombia

Abstract Introduction Extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel disease (IBD). Our objective is to characterise and determine the prevalence of MEIs in our cohort of patients with IBD. Patients and methods A retrospective study was carried out in adult patients with IBD at the Pablo Tobon Uribe Hospital in Medellin. Colombia. Articular MEIs, primary sclerosing cholangitis (PSC), both ophthalmological and dermatological, were considered. Absolute and relative frequencies were used. The Chi square test of independence was used to compare 2 proportions and the odds ratio (OR) was estimated. Results Our registry has 759 patients with IBD, 544 present UC (71.6%), 200 CD (26.3%) and 15 unclassifiable IBD (1.9%); 177 patients with IBD (23.3%) presented EIMs, 123 of 544 (22.6%) with UC and 53 of 200 (26.5%) with CD (OR: 0.81, 95% CI: 0.55–1.17, p = 0.31). Regarding the type of EIMs, the articular ones were the most frequent (13.5%), more in CD than in UC (20.0 vs. 11.3%, OR 1.94, 95% CI: 1.25–3.00, p = 0.0037). Patients with IBD and EIMs used more antibodies against tumour necrosis factor (anti-TNFs), compared to those without EIMs (43.5 vs. 18.5%, OR 3.38, 95% CI: 2.31–4.90, p = 0.0001). Conclusions The prevalence of EIMs in our cohort is high (23.3%) and the most frequent type is joint. Anti-TNFs are most used when IBD and EIMs coexist. Our study provides valuable information on the association of EIMs and IBD in Latin America.

P161 The impact of biologic therapies on Extra-Intestinal Manifestations in Inflammatory Bowel Disease: a multicentre observational study

Abstract Background A high proportion of Inflammatory Bowel Disease (IBD) patients will develop extraintestinal manifestations (EIMs). Choosing the most appropriate therapeutic strategy among currently available biologics for each patient may often be challenging. Data regarding the effects of gut-selective therapies such as vedolizumab (VDZ) on new-onset and pre-existing EIMs are scarce and often discordant. The main aims of this study were to assess the cumulative incidence of new-onset EIMs and the course of pre-existing EIMs in a large cohort of IBD patients treated with VDZ compared to non-gut selective biologic agents. Methods This multicenter retrospective study collected data of IBD patients on biologic therapy in clinical follow-up at 6 tertiary referral IBD units in Lombardy. Clinical and demographic data of IBD patients were collected. We calculated the cumulative incidence of new-onset EIMs since the introduction of the ongoing biologic therapy, comparing patients on VDZ with patients on non-gut selective therapies. Furthermore, we analyzed the course of pre-existing and new-onset EIMs in these two cohorts of patients. Results Data about 973 IBD patients (624 CD, 339 UC, 10 IBD-U; median age 46 years; 59% males) on biologic therapy were collected. Of them, 215 were on VDZ and 758 were on non-gut-selective agents, with a median treatment duration with the ongoing therapy of 3 years. The overall prevalence of EIMs in this IBD cohort of patients was 19.8% (193/973 patients). The overall cumulative incidence of new-onset EIMs was of 4.1 % (40/973): 13 on VDZ (13/215) versus 27 (27/758) in the non-gut selective group (6% vs 3.6%, p = 0.1). Regardless of the type of biologic agents, the female sex and the duration of the ongoing biologic treatment were statistically associated with a higher risk of developing EIMs. About 17% of IBD patients reported a pre-existing EIM. Compared to non-gut selective therapies, patients on VDZ showed a significantly higher rate of worsening or absence of response (8.1% vs 19.4%, 12/148 vs 7/36, p=0.04). However, in both groups, a modification of the therapeutic protocol has been necessary with the introduction of adjunctive therapy, the switch, or the optimisation of the ongoing biologic therapy (27.8% patients on VDZ versus 25% on non-gut selective therapies, p=0.7). Conclusion Our study suggests that the type of biologic treatment does not affect the risk of new-onset of EIMs. However, in the case of pre-existing EIMs, a subtle higher risk of worsening can be speculated after starting VDZ, even if the proportion of patients who will need adjunctive therapy, the optimisation or switch of the ongoing treatment would be similar between gut-selective and non-gut selective therapies.

P114 A screening tool for the early diagnosis of extraintestinal manifestations in inflammatory bowel disease: the EMAIL questionnaire

Abstract Background Data on prevalence of extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) range from 6% up to 47%. Recently, several red flags and questionnaires have been proposed for early diagnosis of articular manifestations. Our aim was to analyse the prevalence of EIMs in a single-centre prospective cohort, using a comprehensive questionnaire developed by our group to detect all EIMs (EMAIL questionnaire). Methods Patients with IBD attending our Clinic from November 2017 to January 2019 were interviewed using a two-part questionnaire, the first part for clinical-demographic data and the second part for EIMs. Patients positive to screening were referred for multidisciplinary approach. Results Two hundred and six IBD patients were interviewed, 114 (55.3%) Crohn’s disease (CD) and 92 (44.7%) ulcerative colitis (UC), 52.4% male, mean age 46.7 years (SD ± 15,2). Sixty (53%) CD patients and 48 (52%) UC patients, in total 108, had history of at least one EIM. Articular EIMs were found in 49 patients (24%); peripheral arthritis was found in 14% (29/206), axial arthritis in 9.7% (20 patients): seven patients (3.4%) had ankylosing spondylitis, 13 (6.3%) sacroiliitis. Cutaneous EIMs were detected in 39 patients (19%), erythema nodosum in 15 patients (7.3%), pyoderma gangrenosum in 9 (4.4%), psoriasis in 15 (7.3%) and folliculitis in 7 (3.4%). Ocular EIMs were observed in 35 patients (17%): uveitis in 7 patients (3.4%), conjunctivitis in 8 (3.9%), optic neuritis in 2, glaucoma in 2 patients, cataract in 13 (6,3%), dry eye in 4 (1.9%), central serous chorioretinopathy in 1. Hepatobiliary EIMs were observed in 31 patients (15%): 26 steatosis (12.6%), 5 (2.4%) primary sclerosing cholangitis. Four (2%) patients had DVT. Articular EIMs were more frequent in CD patients (p = 0.001). Skin manifestations were more frequent in female (p = 0.002) in CD (p = 0,032) and related with IBD activity (&amp;lt;0.001). Hepatobiliary manifestations were more frequent in male (p = 0,017) and in UC (p = 0,044). There was a significant correlation between DVT and IBD activity (p = 0,016). Conclusion The questionnaire developed by our group proved to be a sensitive screening tool. Articular and cutaneous EIMs are more frequent in CD, hepatobiliary EIMs are more frequent in UC. A gender difference has been found since cutaneous EIMs are more frequent in females, hepatobiliary more in males. Cutaneous EIMs and DVT are related with IBD activity.

P238 Natural history of perianal fistulizing Crohn’s disease in the Swiss IBD cohort

Abstract Background Data of large cohort studies on the fate of perianal fistulizing Crohn’s disease (CD) is scarce. We aimed to evaluate the prevalence and natural history of perianal fistulas in adults with Crohn’s disease (CD). Methods Data from the Swiss IBD cohort study were analysed. The Swiss IBD Cohort study includes since 2006 IBD patients, follow-up questionnaires are completed once a year. Patients were recruited from university centres (80%), regional hospitals (19%), and private practices (1%). Results Among 2163 CD patients, 495 (22.9%) ever had perianal fistulas whereas 1668 (77.1%) did not. Patients with perianal fistulas were characterised by the following features when compared with patients without perianal fistulas: younger age at diagnosis (23.4 vs. 25.3 years, p = 0.001), longer disease duration at enrolment (9.6 vs. 4.9 years, p &amp;lt; 0.001), longer disease duration at latest follow-up (17.4 vs. 11.2 years, p &amp;lt; 0.001), less frequenty isolated ileal disease at diagnosis (15.8% vs. 28.6%, p &amp;lt; 0.001), more frequently rectal disease at enrolment (32.5% vs. 14.8%, p &amp;lt; 0.001) and latest follow-up (24.2% vs. 11.7%, p &amp;lt; 0.001), more frequently acne inversa (1.4% vs. 0.1%, p &amp;lt; 0.001), and more frequently intestinal resection (49.5% vs. 35.3%, p &amp;lt; 0.001). The prevalence of extraintestinal manifestations was not different (59.0% vs. 54.4%, p = 0.073). Compared with patients without perianal fistulas, patients with perianal fistulas were more frequently treated with topical 5-ASA (14.8% vs. 8.0%, p &amp;lt; 0.001), systemic steroids (78.2% vs. 70.1%, p &amp;lt; 0.001), azathioprine (82.6% vs. 77%, p = 0.008), methotrexate (28.3% vs. 22.2%, p = 0.005), infliximab (71.9% vs. 50.8%, p &amp;lt; 0.001), adalimumab (36% vs. 27.9%, p &amp;lt; 0.001), certolizumab pegol (18.6% vs. 11.5%, p &amp;lt; 0.001), and antibiotics (69.1% vs. 41.2%, p &amp;lt; 0.001). Regarding fistula anatomy, 321 patients (64.8%) had a low perianal fistula, 82 (16.6%) a high perianal fistula, and 227 (45.9%) a perineal fistula. The following fistula therapies were ever applied: perianal abscess drainage (45.7%), fistulectomy/fistulotomy (39.6%), seton drainage (28.7%), mucosal sliding flap (2%), fistula plug (1.4%), and fibrin glue instillation (1%). Conclusion In our national cohort roughly one-quarter of CD patients was diagnosed with perianal fistulizing disease. Compared with patients without perianal fistulas, patients with perianal fistulizing disease were characterised by several stigmata of complicated disease course such as a higher frequency of intestinal resections and higher prevalence of treatment with biologic agents.

Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms.

Celiac disease (CD) is a systemic autoimmune disease due to a dysregulated mucosal immune response to gluten and related prolamines in genetically predisposed individuals. It is a common disorder affecting ~1% of the general population, its incidence is steadily increasing. Changes in the clinical presentation have become evident since the 80s with the recognition of extra-intestinal symptoms like short stature, iron deficiency anemia, altered bone metabolism, elevation of liver enzymes, neurological problems. Recent studies have shown that the overall prevalence of extra-intestinal manifestations is similar between pediatric and adult population; however, the prevalence of specific manifestations and rate of improvement differ in the two age groups. For instance, clinical response in children occurs much faster than in adults. Moreover, an early diagnosis is decisive for a better prognosis. The pathogenesis of extra-intestinal manifestations has not been fully elucidated yet. Two main mechanisms have been advanced: the first related to the malabsorption consequent to mucosal damage, the latter associated with a sustained autoimmune response. Importantly, since extra-intestinal manifestations dominate the clinical presentation of over half of patients, a careful case-finding strategy, together with a more liberal use of serological tools, is crucial to improve the detection rate of CD.

Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients

BackgroundThe prevalence of inflammatory bowel disease (IBD) in South Korea is increasing. Although extraintestinal manifestations (EIMs) are an important factor in the clinical outcomes of IBD patients, EIMs have not yet been investigated in Korea. Thus, we conducted a cross-sectional study to assess the prevalence of EIMs in Korean IBD patients.MethodsThe 2014 claims data from the National Health Insurance System (NHIS) of Korea were used. IBD patients were identified by codes for Crohn disease (CD) and ulcerative colitis (UC) in the NHIS registration system for rare or intractable diseases. International Classification of Diseases, Tenth Edition codes were used to identify EIM cases. To estimate the prevalence of EIMs in the general population of Korea, we used national sample data. Standardized prevalence ratios (SPRs) were calculated to compare the prevalence rates of EIMs among IBD patients to those among the general population of Korea.ResultsA total of 13,925 CD patients and 29,356 UC patients were identified. CD and UC patients were different in terms of demographics and utilization of medication. Among the 17 EIMs investigated, pyoderma gangrenosum, osteomalacia, Sweet syndrome, and scleritis were observed in very few patients. The SPRs were greater than 1 for all EIMs. Aphthous stomatitis, rheumatoid arthritis, and osteoporosis were highly prevalent in both CD and UC patients, but the SPRs of the EIMs were not high.ConclusionThe study confirmed that EIMs are more prevalent among IBD patients than among the general population of Korea. The prevalence of EIMs in IBD patients suggests the need for greater attention and effort in clinical practice.